Personal Medical Information

This information is for use in the event that someone is injured seriously enough to require evacuation from the Canyon. Please fill it out, place it in the envelope and write your name on the outside of the envelope. Al & Dave will keep these with the major medical kit.

Name
Address
Persons to notify in event of an emergency: name, relationship, phone #
Personal Doctor(s), name & phone #:
Medications being taken, name & dosage:
Allergies:
Any Important Medical Information -
Insurance Information – Policy #, Carrier